Provider Demographics
NPI:1558506139
Name:TENNEN, EDWARD F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:TENNEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CENTER ST STE 112 PMB 5075
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7212
Mailing Address - Country:US
Mailing Address - Phone:828-423-0427
Mailing Address - Fax:
Practice Address - Street 1:201 E CENTER ST STE 112 PMB 5075
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-7212
Practice Address - Country:US
Practice Address - Phone:828-239-9340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22365103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical